Active NPI
Jill M. Komura, LMHCA
- Mental Health Counselor
- Olympia, WA
National Provider Identifier
1275275315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 60861950
- Practice address
- 203 4TH Ave E Ste 221
Olympia, WA 98501-1187 - Phone
- (360) 539-1230
- NPI assigned
- Apr 9, 2022
- Last updated
- Apr 9, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 60861950 | WA | Primary |
Addresses
Primary practice location
203 4TH Ave E Ste 221
Olympia, WA 98501-1187
Mailing address
PO Box 7307
Olympia, WA 98507-7307
Phone (360) 539-1230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 10, 2026 through May 10, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60861950 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649462400000",
"number": "1275275315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7307",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985077307",
"telephone_number": "360-539-1230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 4TH AVE E STE 221",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985011187",
"telephone_number": "360-539-1230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMURA",
"first_name": "JILL",
"middle_name": "M.",
"credential": "LMHCA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-09",
"last_updated": "2022-04-09",
"certification_date": "2022-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "60861950",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.